Insurance

A Review of Current Issues

The mission of The Greenbrier Clinic is to excel in the provision
of comprehensive, adult diagnostic and preventive health care. An
individualized approach, employing state-of-the-art equipment and
testing procedures is coordinated over a two day period by medical
staff and employees committed to making this process as
comfortable, convenient, and informative as possible. In addition
to evaluating any current problems or symptoms, your doctor will
analyze your risk for other diseases and may recommend "screening
tests" to detect problems such as cancer and heart disease in their
early stages.

Many patients ask if their health insurance and/or Medicare will
cover all or a portion of their Clinic examination. While most
insurance plans and Medicare cover some portion of limited
screening or preventive health services, many such tests are not
covered. Tests such as chest x-rays, exercise stress tests,
flexible sigmoidoscopy, cholesterol levels, blood tests for thyroid
and liver function, and diabetes are examples. If such tests are
performed for evaluation of specific symptoms or findings, they may
be covered, but generally they will not be covered if performed for
screening purposes. If you have questions regarding which screening
services may be covered by your health plan, please contact your
insurance carrier before your Clinic examination.

The Clinic is required by law to bill for all services using
numerical "codes" that identify what tests were performed and why.
The codes also identify the service as a diagnostic service or a
screening service. An example of a screening test might be an
exercise stress test in a patient with elevated cholesterol and a
family history of heart attack, but no symptoms suggesting heart
disease. Other examples might be tests performed to detect cancer
in its early stages. Although doing such tests might be appropriate
and desired by the patient, strictly speaking they are "screening"
tests and must be coded as such by the Clinic. The use of these
codes may reduce your reimbursement from an insurance carrier, and
increase your out-of-pocket expense.

Medicare does not cover general preventive physicals. It does
provide a very limited amount of preventive services. Medicare does
cover annual breast examinations and mammograms; periodic pap
smears; and colorectal cancer screening (every four years). It also
covers annual prostate cancer screening for men which includes a
digital rectal exam and a PSA blood test.

If Medicare is your primary insurance, please note: As a
courtesy to our Medicare patients prior to 2000, the Clinic
included codes in its Medicare billing for services Medicare
considered to be "non-covered services". Medicare denies these
services but occasionally secondary insurance covers them.
Medicare's current policy is that they do not wish to have claims
for "non-covered services" submitted. However, if you do have
secondary insurance, we may, with your written authorization, bill
for a denial. If you are a Medicare patient with no secondary
insurance, these charges will be included on the bill you receive
from the Clinic.

The Greenbrier Clinic is a participating provider with Medicare.
The Clinic is not a participating provider with any managed care
plan and most insurance plans. This means that if your insurance
carrier covers a service but approves less than the Clinic's fees,
you will be responsible for reimbursing the Clinic for the
remaining balance of the total billed.

The only exceptions to this are beneficiaries of the West
Virginia Public Employees Insurance Agency (PEIA). We are required
by law not to balance bill the non-allowed amounts determined by
their fee schedule. The Clinic can bill its full charges to PEIA
patients for services that are determined by PEIA to be non-covered
services.

The Clinic cannot predict the total cost of your examination:
The cost of our basic examination begins in the range of
$1900-$2200. This can vary greatly depending upon your age, general
health status, family history, ongoing symptoms, and any additional
problems you wish to have addressed. The total bill may be as high
as $4000-$6000 or more when symptoms requiring multiple
sophisticated tests are evaluated. Insurance reimbursement often
reduces out of pocket costs.

Patients who wish to receive the Clinic's expertise in the
evaluation of a condition or problem, but do not want the
comprehensive Greenbrier Clinic examination, may schedule a
problem-focused examination on a "space available" basis. If you
choose this option, you will receive a high quality Greenbrier
Clinic evaluation limited to your current symptoms or problems.
This examination does not include screening tests or preventive
health services and should not be considered a substitute for the
traditional Greenbrier Clinic comprehensive evaluation.

As a courtesy, the clinic will continue to prepare and file your
insurance claim forms for the services you received while a patient
at the Greenbrier Clinic. This service is unique to the Greenbrier
Clinic in fact many of our competitors no longer bill insurance but
provide you with a super bill. This is a form used in the industry
with the diagnosis and all appropriate coding information for
services received so you can personally attempt to bill your
insurance on your own. Some of these same organizations even refuse
to accept Medicare patients in their Executive Health programs
which we continue to accept. We feel that in today's complex
healthcare market it is important for the Greenbrier Clinic billing
and coding experts to continue to assist our patients in preparing
and then submitting the forms. This is one of the many services we
provide that continues to separate the Greenbrier Clinic from the
rest of the industry. Our highly trained billing and coding staff
have years of experience preparing and submitting your insurance
forms to assure, under the law, maximum allowable reimbursement
from your insurance carrier.

Effective immediately each time you check in
you will now be asked to sign a credit card authorization form.
This information will be held securely and only used to pay for the
portion of your exam that your insurance did not cover .
Additionally the new policy will also allow the clinic to bill your
credit card in those instances when your insurance carrier pays you
rather than the clinic. We will allow 60 days for your insurance
company to process your claim and pay you for those services that
are covered.

At that point (60 days from date of services) we will now bill
your credit card for the outstanding balance on your account. In
order to minimize the amount billed to your credit card you should
promptly send any money received from your insurance company for
the services you received at the Greenbrier Clinic. Routinely
our billing department will submit your claim electronically within
days of your clinic visit. Historically, insurance companies will
process your claim in 45 days or less.

The Greenbrier Clinic has reluctantly had to adopt this new
financial policy in order to expedite the patient's portion for
services rendered. This is a continuing and rapidly growing problem
and for years the clinic has refrained from implementing such a
policy but to remain competitive and a leader in the industry we
must change.

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History

James Monroe

James Monroe visited White Sulphur Springs with his wife in August 1815 while he was Secretary of State. His physician ordered him to “take the waters” to regain his health.

Ulysses S. Grant

Ulysses S. Grant visited White Sulphur Springs in 1874. It was a brief visit early in the season as he was traveling west by railroad.

Woodrow Wilson

Woodrow Wilson spent his Easter vacation in April 1914 at The Greenbrier. He played golf on the Old White Course. He also divided his December 1915 honeymoon with Edith Bolling Galt between The Greenbrier and The Homestead.

William Howard Taft

William Howard Taft vacationed at White Sulphur Springs during his 1908 campaign for the presidency. He was feted at a grand ball in the ballroom of the Old White Hotel.

Dwight D. Eisenhower

Dwight D. Eisenhower hosted the North American Summit Conference at The Greenbrier March 26-28, 1956. He was also at the resort three times in World War II when The Greenbrier was used as an Army hospital. Once he was admitted as a patient and the other times he was here with Mrs. Eisenhower for rest and relaxation.